Symptomatic spondylolysis: diagnosis and treatment.

PURPOSE OF REVIEW: Approximately 35% of adolescents experience back pain. In athletic adolescents, spondylolysis is the most common offending cause. With growing numbers of adolescents participating in sports with higher levels of intensity, spondylolysis is becoming an increasingly common clinical problem.

RECENT FINDINGS: A recent report demonstrated the benign natural history of asymptomatic spondylolysis. However, long-term follow-up studies of patients who experience painful spondylolysis as adolescents remain unavailable. Modern imaging modalities have led to earlier diagnosis with greater accuracy. Conservative management with bracing continues to be a mainstay of treatment. In patients who are not helped by conservative therapy, recent studies have demonstrated the satisfactory long-term results of surgical repair.

SUMMARY: The long-term sequelae of symptomatic spondylolysis and unhealed pars defects require investigation. MRI promises to be a valuable tool for diagnosis and clinical stratification, but further studies are necessary to demonstrate its clinical utility.